This proposal seeks to study a new way of delivering care to older adults and is in response to research objective 23: Care for Older People For the past two decades, policy analysts have struggled to find solutions for rising long-term care costs for chronically impaired older persons. One answer is to bring care to patients in their homes. However, even the booming home health industry is not immune to environmental constraints and took a major financial hit with the implementation of the Balanced Budget Act. Thus, home health providers now find themselves in the unique position of perhaps offering senior citizens the easiest access to care which can prevent or postpone the need for more costly institutional care. Yet, these same providers must also find cost-effective ways to deliver this cart. This project proposes a preliminary study which first looks at the feasibility and organizational delivery impacts of monitoring chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) patients who are attempting to manage their condition without prescribed home health services. It will serve as a preliminary study for a larger scale project which will lengthen the continuum of care to include evaluation of day-to-day monitoring as well as prescribed home health. What makes this project unique is the application of telemedicine technologies to deliver these services to patients' homes. Telemedicine, the use of telecommunication technologies to deliver health services over a distance, has been shown to be a feasible means to deliver care. However, other than simple feasibility and satisfaction studies, research reveals little about how telemedicine will impact the delivery of home health services. This project seeks to look at the impact of telemedicine on a special group of home health patients, namely rural senior citizens. Telemedicine is a particularly attractive potential solution for this population who is often so isolated from health providers. Telemedicine includes both interactive videoconferencing as well as telemonitoring which is the use of tools that can capture patient's vital and physiologic signs (Kinsella, 1997). Equipment will be installed in the homes of patients receiving care from a physician practice affiliated with a health system in rural Kansas. Patients diagnosed with COPD and CHF will be randomly assigned to one of three groups: (l) a group that receives daily monitoring via interactive video and telemonitoring devices; (2) a group that receives telemedicine services solely via telemonitoring devices and; (3) a group that receives no intervention. This project will study the impacts on the patient, family caregivers and health providers resulting from this intervention and has four specific aims: (l)To document patient acceptance and utilization of the home monitoring equipment, and to evaluate whether patients prefer video interaction as well as data monitoring or whether simple data monitoring is sufficient; (2) To determine how the health provider incorporates telemedicine and the data it provides in the care of participating patients; (3) To document and compare access to health services by telemedicine and control group subjects; (4) To document differences in the health-related roles and responsibilities of the providers, patients and caregivers for both delivery modalities. This pilot grant seeks to document key issues in the use of telemedicine from a delivery perspective. This project serves as a preliminary to a full proposal (ROl) and is needed to document how telemonitoring is employed in the home as well as the optimal delivery scheme for bringing these services into the home. The ROl to be submitted from this project will further study the impacts of telemonitoring and will extend analysis to patients who are prescribed formal agency-delivered home health services through the use of telemedicine. This larger project will compare impacts of telemonitoring and agency home health care by examining clinical outcomes, efficacy, cost, changes in the delivery structure, and satisfaction. Most importantly, this research may serve as an important contributor to policy makers as home health care legislation evolves.